Jiggered: The Healthcare Insurance Industry; Unraveled, Explained and Exposed

By C. E. Nash

No matter what type of healthcare insurance coverage you have, Jiggered will help you understand where you fit into the overall scheme of things, how your specific type of insurance works and how it will be affected in both quality and quantity over the next few years. Youll find that the only real crisis in healthcare is the one caused by the Federal governments inability to fiscally control and monitor itself.

Who is being jiggered? Who is being unethically manipulated for someone elses gain? Its probably you and everyone like you. You have a job, pay your taxes, feed, clothe, educate and insure your children, own a home or are saving for one and generally behave in a lawful, fiscally responsible and upstanding manner. Youre an ordinary upper or middle class American. Some of you have made it through the daily struggle to realize your dreams and have found financial rewards and others of you are still working at it. You all have one thing in common. Youre part of the solution, not part of the problem. Are you jiggered? You figure it out.

• Language: English
• Publisher: iUniverse
• Release date: Sep 23, 2010
• ISBN: 9781450256377

C. E. Nash

Biographical Sketch I like to think of myself as one of the first in a long line of baby boomers. Born between the bombings of Hiroshima and Nagasaki, I was raised in post World War II America when telephones and TVs were yet to become commonplace in the American home and girls were expected to marry, provide a peaceful well organized home life and produce children for a working spouse. Fortunately, my parents were supportive of all endeavors I attempted, contrary to traditional expectations and firmly believed I would be able to succeed at whatever I undertook. The only career options my father ruled out for me were, of course, my first two choices; firefighter and professional football player. He didn't think I would do well at either, partially due to my sex; and partially my diminutive size. I was raised with five siblings in an atmosphere of strict obedience as were most children during the 1950's; the era of “spare the rod, spoil the child”. However, as long as house rules were followed, personal creativity and accomplishments were wholeheartedly supported provided we were willing to work for the funds needed to make our endeavors possible. Nothing was ever arbitrarily handed out. My parents simply had virtually nothing to hand out. They were, in fact relatively poor with little money left at the end of a work week to spend on anything frivolous. Just feeding, clothing and educating six children was an enormous and financially consuming task. I began my professional career at the age of 17; the day after I graduated from high school. One of the unbreakable house rules; upon completion of high school, we were required to land a full time job and pay room and board. I had a full time job at the Quaker Oats Company in their finance and accounting division by the end of the first day in my job hunting adventure. I spent nine years in the financial division of the same company before deciding I didn't like my job. However, it was time well spent. Both the formal and business educational experiences I received during those years were certainly put to good use in later life. By the time I was 18, I had moved from home into an apartment with two friends and was essentially on my own, albeit with considerable assistance from my parents who firmly believed they had raised me with sufficient knowledge and good sense to enable me to survive on my own. In their eyes, I was an early success; out of the nest sooner than my siblings other than two brothers who had joined the military. During their all too brief lives, I maintained a close and loving relationship with my parents who were both deceased by the time I reached my 29th birthday; my father at the age of 51 and my mother at the age of 52. During my stint in the business world, I also did the appropriate thing and married a young man who was considered a "good" potential provider and an excellent candidate for the job of future father to my unborn children. My children remained unborn and I spent nineteen years in the relationship before deciding I didn't like my marriage any better than my career in accounting. I changed careers, became divorced before it was a commonplace everyday occurrence and began my advanced educational process all over again, studying biology, math, humanities and American history (just for fun) with a major in the field of respiratory care. However, once again, after spending ten years working in the healthcare setting, I decided I didn't like my job. I did, however, like my career choice, so I knew I was edging ever nearer to my own brand of personal and professional satisfaction. I left the hospital setting to set up the first of three companies I would sequentially start up and run. My time in the financial and hospital setting was well spent. While working in the hospital, I taught medical residents and respiratory care students in the clinical setting and spent five years engaged in medical research projects under the guidance of my medical director. As one promotion after another came along, I was instrumental in developing medical policies and procedures as well as development of educational programs within the structure of the healthcare industry. I have no idea what possessed me to strike out on my own in the business world and I nearly starved while setting up my first company; living on an extensive diet of ramen noodles and peanut butter. Within a year, I had a viable teaching company established which realized small year end profits, and was teaching CPR and Fist Aid to small business. I liked the concept of having succeeded at what I set out to do, but got very tired of the repetition in the day to day activities of my company.I found that managing employees was much like trying to herd cats; exhausting on a good day. I liked being my own boss but still didn't really like my job yet. I had not completely abandoned my healthcare career and provided medical support to air and ground ambulance transport teams throughout the world while running my education company. The travel was extensive, challenges were consistently difficult and the pay stunk. Now, I finally liked my job, but didn't like the constant focus of my employers on getting in the money; making a profit at any cost, then providing care for the patients. I certainly did not like my income. I thought I could and should do a better job. I started my second company by providing contract Nurses and Respiratory Therapists to the ambulance transport industry while personally continuing to do transports as well. Within a year from startup, I once again had a viable small business which netted a very small profit at the end of its first year. I liked that job but its time was limited. Early on, the handwriting on the wall told me it was only a matter of time before the ambulance companies hired their own medical staff to provide these services. I really liked that job, however, it was self-limiting. I opened my third company by simply expanding into the ambulance transport business with my own vehicles where I have remained active and relatively content. This time, it took five years to financially stabilize the company and simply break even. I really think I like this job and may have finally decided what I would like to do when I grown up. I’m satisfied with paying decent salaries to my staff, managing to keep nearly even with business expenses and occasionally come out with a small profit at the end of the fiscal year. Having worked in all aspects of the healthcare industry has given me sufficient education, experience and insight into the industry to enable me to write “Jiggered”. I really don't know what I’ll do next. I’ve never really planned my life in advance with the exception of a marriage which really didn’t work well for me anyway. I’ve simply explored the opportunities placed in front of me; some of which have worked and others which have not. At the age of 65, I don’t feel any need to actively seek challenges. Based on my previous life experiences, challenges will certainly come along unbidden and like a moth drawn to a flame, I will continue to be drawn to new challenges as long as I am physically and mentally capable of responding. I’ve come to the conclusion that I’m only truly happy when challenged. I love to read and make time to do so every day. I would consider myself lost if I ran out of reading material and would most likely resort to reading the nutritional contents on my cereal boxes to prevent reader’s withdrawal. I studied fine art for two years at the American Academy of Art in Chicago and someday hope to return to painting in oils. At present, I content myself with spending time working with many old fashioned forms of needlework which my grandmother began teaching me as a small child. I have always loved the history of my country and wish time machines were a reality. I’d travel by wagon train, go to California during the

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Dedication:

This book was written for you; the hard working, taxpaying citizens of the United States of America. You epitomize everything that’s good, desirable and special about this wonderful country. You deserve the truth.

Preface:

This isn’t a wildly exciting book. It’s not a 350 page great American novel but it does have its compelling moments. It addresses the on-going controversy over the passage of Obamacare legislation and how it affects the relationship between healthcare providers and patients within the complicated structure of the insurance industry. It gives a detailed explanation of exactly how the healthcare systems and the insurance industries in this country operate and how that process will be changed with the advent of Obamacare. No matter what type of healthcare insurance coverage you have, this book will help you understand where you fit into the overall scheme of things, how your specific type of insurance works and how it will be affected in both quality and quantity over the next few years. You’ll find that the only real crisis in healthcare is the one caused by the Federal government’s inability to fiscally control and monitor itself. Federal programs are out of control. While there are many problems in the private insurance sector as well, those problems are far more easily correctable without a major overhaul of a well functioning industry. You should also be aware that this book is going to make you angry, so make certain you don’t skip your blood pressure medication. If you pay attention to what’s written here, you’ll find yourself possessed of sufficient knowledge to skillfully navigate the pitfalls you’re going to experience as a consumer in the insurance industry and as a patient in the healthcare system. You’ll also find out who some of the good guys and bad guys are and how they’re helping or hurting you, the American consumer.

In all the hoopla that surrounded the passage of Obamacare, the healthcare industry was eerily silent. At any moment, I was expecting providers to rise up as a group, as a unified voice to protest and set everyone straight about the horror that was about to take place in this country. It just didn’t happen and I couldn’t understand why. Why would the people most intimately involved in the healthcare system sit silently by the sidelines while their vocations were destroyed? Not until I sat down and gave it serious thought; not until I mentally dissected all of the elements that go into providing a healthcare product from start to finish, did I realized that very few healthcare providers have an intimate perspective of all aspects of healthcare.

Most healthcare providers simply do not have a clear and under-standable point of presentation from which to launch an argument. They don’t have the broad spectrum of personal insight and experience that it takes to present the subject in its entirety in a concise and well organized manner. The industry is simply too large and split up into too many different disciplines to allow most healthcare providers the clarity of view necessary to present a well informed, complete and concise overview of the subject. And then I realized that I should have understood this much sooner and spoken up to any and all who would listen. What makes my perspective unique? I’m a healthcare provider, a small business owner and I understand the money. I really, really, really understand the money. That’s the key. It’s an understanding of that money part that’s relatively uncommon.

Very few healthcare providers handle their own billing. They use huge companies who specialize in the convoluted process of billing Medicare, Public Aid, private insurance and patients. Their payroll is handled by another company that specializes in the complexities of labor laws, employee benefits and State and Federal taxes. They have office managers who organize records and manage day to day activities for them and accountants who handle the intimate details of their finances; lawyers who handle collections and lawsuits. In fact, most healthcare providers have hired a complete array of specialists to handle all the complicated behind the scenes details of their businesses so they can get on with the process of providing healthcare. No single discipline in the healthcare industry has a thorough, in depth understanding of another. Healthcare is truly the sum of all of its parts and each of those parts is a separate complicated piece of the puzzle being handled by a specialist. It takes an expert to handle each of those segments efficiently. The expert in medical billing really doesn’t know what the expert in payroll is doing. When it comes to the healthcare industry, the left hand truly doesn’t know what the right hand is doing.

When I started out in healthcare and set up my own company I was blissfully ignorant of this complicated structure. I had a background in finance and accounting left over from a previous life, so in my naive ignorance, I firmly believed that I could provide healthcare and handle everything else as well. When it comes to money, I have always operated on the basic premise that no one would ever watch over my finances as diligently as I would myself. I look back now and wonder how in the world I managed it. It’s incredibly complicated on a good day. However, through a perfect mix of naiveté, stubborn determination and an unwillingness to even think of admitting defeat, master it I did. It all came together as a complete package! Now, in another example of that same blissful ignorance I seem to be so abundantly possessed of, I’m going to write a nationwide best seller; right? So what if I’ve never written a book before. I’ve read scads of them. I should be able to do this because once again, I’m blissfully ignorant of the process.

Introduction:

Who is being jiggered? Who is being unethically manipulated for someone else’s gain? It’s probably you and everyone like you. You have a job, pay your taxes, feed, clothe, educate and insure your children, own a home or are saving for one and generally behave in a lawful, fiscally responsible and upstanding manner. You’re an ordinary upper or middle class American. Some of you have made it through the daily struggle to realize your dreams and have found financial rewards and others of you are still working at it. You all have one thing in common. You’re part of the solution, not part of the problem. Are you jiggered? You figure it out.

Make no mistake about it. The healthcare industry is business; big business; and many aspects of its daily, behind the scenes functions are dirty, corrupt and ugly. And yet, as a career it can be wonderfully uplifting and rewarding. Healthcare is not an inalienable right! Inalienable is defined as something which is impossible to take away; intangible and in the United States, when coupled with the word rights, is protected by law. Tangible objects such as goods or services are not described as inalienable and are not protected by law in the same sense. Traditionally, inalienable rights were defined in the Declaration of Independence and were comprised of life, liberty and the pursuit of happiness; all intangible. The key here is the word rights. We can’t walk out and purchase rights, stuff them in a plastic bag and carry them home with us. They’re abstract ideals. Healthcare simply doesn’t fit into that description. Healthcare is anything other than an abstract ideal.

Healthcare is a fee for service product which generates revenue and incurs costs on the part of providers as well as financial obligations on the part of consumers. No one should ever presume to think they have a right to consume a healthcare product without payment of any kind. Yet countless numbers of people in the United States believe it should be free; that the government should provide for their healthcare needs. And, in far too many cases, the government, through its entitlement programs does just that. But it isn’t free folks! The government uses income tax revenues right out of the pockets of working upper and middle class Americans to provide free healthcare to millions of people who pay nothing for it; some of whom genuinely need assistance and many others who simply scam the system. When anyone consumes healthcare, they’re consuming a product that has production and delivery costs. It isn’t free.

Corruption in the industry extends from the government at the top

and includes every aspect of healthcare all the way down to the consumer; yes, you down at the bottom of the healthcare food chain. We just witnessed a magnificent example of Government corruption with the passage of Obamacare. If an ordinary citizen engaged in similar arm twisting, coercion, payoffs and back door dirty deals like those we witnessed in congress, he or she would most likely end up doing prison time. But hey folks, that’s just how it’s done in Washington. Working, upper and middle class Americans are on the hook for Obamacare. You’re already the sole source of support for the current healthcare system in America and you’re about to experience ever increasing, in fact possibly devastating financial responsibilities in order to fund Obamacare. Look around! There isn’t anyone else to support healthcare in this country. The Feds have no other source of income to support their healthcare agenda. If funding doesn’t come from you, where will it come from? You have a whole new set of entitlement expenses to cover for the rest of this country. More than ever, you need to understand how this system works. Mr. Obama needs to redistribute your wealth. If you have more than your neighbor, you need to fork it over.

What about the rich? The government is going to take increasing amounts of money from the rich so you can have free healthcare; right? Well, the simple fact is that there aren’t enough rich people out there to cover the cost of all the government sponsored entitlement programs functioning at the present time, let alone additional ones that we face with new Obamacare mandates. How are you going to find more rich people? You’re not going to. They’re becoming an endangered specie. Who ever decided we should penalize the rich anyway? How many of you reading this would like to be rich? I know I would love to be rich. I could buy new ambulances for my business and hire more people, buy a bigger building so my employees are not tripping all over each other, give out well deserved raises, and the list goes on. Never knock the rich. They employ you and pay your salaries. Take their money away and you lose jobs. Right now, most business owners are not willing to invest in any kind of business expansion. They don’t dare. They have no idea what’s coming down the line from the Feds. Every time they turn around, they’re faced with new expenses to provide the tax masters in Washington with more funds to support a flagging economy. It’s going to continue to spiral downward as long as business owners have more and more taxes piled upon them. With no relief in site, they’ll remain in survival mode and unemployment will remain high.

What is rich? Mr. Obama thinks he can place a specific dollar amount on rich. His numbers keep changing so its impossible to tell what he thinks rich is right at the moment. However, for the sake of argument, let’s just say his threshold is $250,000.00 per year. If you earn more than that, you’re rich enough to pay higher taxes. My company had a gross income of $2,500,000.00 last year. Am I rich? Should my taxes go up? After all my expenses, my corporate net profit was $1,306.00. Talk about cutting it close. The largest net profit my company ever realized was $65,000.00 and I can guarantee you, the government quickly snatched up its share. I didn’t even have enough left over to buy a new ambulance which I desperately needed. Increase my taxes and I’m either out of business with 45 newly unemployed workers on the street or you’ll have to pay even more money when I transport you in one of my ambulances. And to answer your next question, no I don’t take money out of the company for my own personal use. I take a standard salary of $74,000.00 per year and pay my taxes through payroll deductions just like you. I consider the right to pursue, not necessarily to achieve wealth to be desirable; something I would like to achieve. I’m a year away from retirement age and still vigorously pursing that elusive thing called wealth. Somehow, I don’t think that a landmark birthday will shut down that drive to pursue; that hope of success. Pursuit! Now that folks, is an inalienable right.

Who am I to tell you all of this; to lecture you? I’m an insider; an insider with a unique position in healthcare that gives me a complete view of exactly what’s going on in the industry from the perspective of both healthcare provider and small business owner. More importantly, I’m an angry insider. Angry at what this country is doing to its perceived wealthy and working class citizens of which I am one. I am strictly middle class by birth, middle class in thought, initiative and perspective and I’m justifiably proud of it. It’s middle class initiative that keeps the productive wheels of this country turning. Those wheels are slowing down. If the Feds are not very careful those wheels may become mired and bogged down in the debris of Obamacare.

Being in the healthcare industry has many rewards and benefits. It provides personal satisfaction and reasonably decent financial rewards. Even in poor economic times, there are usually still some jobs to be had. Most people who enter into the system as caregivers are not solely motivated by financial gain. They have a genuine interest in some facet of healthcare and in the human condition in general. If they achieve reasonable financial security, that’s a good thing.

Many healthcare providers believe that the healthcare industry is economically bulletproof. In the past, that was true to a certain extent. Even in the worst of times, there are always sick people to take care of. Now, that remains to be seen. If providers are unable to cover the cost of providing services, those services will become very scarce indeed. By and large, the people who are providing your healthcare are not your financial enemy. Yes, that’s who you get your bills from, but they’re only the messengers. Providing your healthcare is unbelievably expensive, yet less than half of you are covering the cost to provide healthcare for the entire nation. Your President, with the help of his majority congress has decided who’s going to get healthcare and how much of it they can have. However, he hasn’t told you the truth yet about who’s going to pay for it. Washington has many of you convinced that it’s not going to affect you. That you’re actually going to benefit. I’m about to correct that minor little misconception.

If you’re a member of upper or middle class working America, you need to read this book. You not only need to read this book, you need to do something about the inequities in the system. The very last thing you can possibly believe is that a pack of Washington bureaucrats has the solution. I will have done my part by empowering you with the ammunition to change what’s happening. As they say, knowledge is power. Use it wisely; Use it peacefully; Use it fairly. Most of all, use it at election time. If you’ve never voted before, now’s a great time to learn how to do it! Don’t be shy about asking for help. I’d be willing to bet that